Health, Education—and Welfare?

Often discussed in different sections of the newspaper or the blogosphere, the twin crises of health care and higher education are extraordinary in their similarities. Both are regarded as necessary goods for human flourishing whose costs are spiraling out of control. Both rely on a professional class that is becoming more specialized, losing the generalist who once cared for the “whole person.” Both have seen expanding intervention by the central government which has sought to provide access to the lower and middle classes. Both are believed by many conservatives to be properly reformed by means of market-based solutions. Both are the subject of intense contemporary political debate.

And both were once almost exclusively the province of the Church, and, indeed, can trace their institutional origins—hospitals and universities—as part of the Church’s charitable ministry.

This latter fact, it seems to me, sheds bright light on the common roots of the contemporary crisis of each area. The dominant voices in the debate in both areas—health and education—cleave closely to the contemporary party lines. On the Right, the case is made that a competitive market model will solve the ills of both health care and education. By allowing prices to be driven by supply and demand, and the motivations of the primary actors—doctors and professoriate, on the one hand, patients and students, on the other—to be largely self-interested, the market will resolve how best to allocate the relatively limited access to the best health care and the best institutions of higher education. On the Left, it is believed that the State should rest a heavy hand on the scales of the market, enforcing widespread access, suppressing costs (or providing subsidies), and forcing providers to conform to state-mandated expectations and standards.

Yet there is something fundamentally amiss with making provision of health and higher education contingent on market models and profit calculus, as both seem to be goods that are not subject to the same kind of calculus as automobiles and bubble gum. The very idea that doctors and teachers are or ought to act out of the motivations of self-interest, and provide services to their “consumers,” seems fundamentally contradictory to the kind of work and social role performed by each. The decline of the “generalist” in each sphere is indicative of a deeper crisis of the willingness to act on behalf of a broader conception of the good intrinsic to each profession and on behalf of the person being served, in favor of the specialization encouraged by modern canons of efficiency, productivity, profit, and rationalization.

At the same time, the State is rightly suspected of being unable to fundamentally improve or even maintain the quality of either sphere. It is doubtless the case that it can assure access by the heavy hand of threats, but many rightly worry that, as a consequence, the quality of care and education will deteriorate as a result. The State takes on the ersatz role of “generalist,” seemingly concerned for the good of the whole. It can only pursue that good by seeking to control pricing and access while influencing the ways “care” is provided, but it fails necessarily in caring for the vision of the whole that the actors of the professions are no longer willing or able to perform.

The debate as currently constituted represents a pincer movement aimed ultimately at the re-definition of each area—as we have seen in so many areas of contemporary life. While superficially opposites, proponents of each position in fact share a fundamental hostility to the original presuppositions that had informed the foundation of both institutions—the corporal works of charity central to the Church’s earthly mission.

In fact, it seems increasingly evident that practices such as health care and education are likely to fail when wholly uninformed by their original motivation of religious charity. Neither functions especially well based on the profit-motive or guided by large-scale national welfare policies. As the failure of the market model in each area becomes evident, the demands for the second—government intervention and control—have quickly followed. That both are reaching crises at the same time is hardly coincidental: both benefitted for a long time from the “social capital” accumulated as Church institutions, a legacy of cultures and practices that persisted for a long time even after the practitioners had ceased to embrace them. However, in both cases, the social capital is now depleted, and each now operates on a nonsensical combination of self-interested market motivations and taxation and threat-based national welfare policy. Neither is a fitting motivation or model for either sphere.

Even more deeply still, it is not untoward to speculate that part of the modern project is eventually to drive the Church from the dominant, and even residual, place of trustee in all areas of life where it once reigned. The market and State have infiltrated all areas where once the Church was the main actor, transforming institutions ranging from schools to land-stewardship to charity to marriage simultaneously in the image of market-based individual choice and nationalized demands for equalized homogeneity.

The motivation of charity is deeply suspect by both the Right and the Left. The Right—the heirs of the early modern liberal tradition—regard the only legitimate motivation to be self-interest and the profit motive. They favor a profit-based health-care system (one explored to devastating effect in this recent article on health care in the New Yorker), and a utilitarian university (the “polytechnic utiliversity” ably explored by Reinhard Huetter in the most recent issue of First Things).

The Left—while seemingly friends of charity and “social justice”—are deeply suspicious of motivations based on personal choice and religious belief. They desire rather the simulacrum of charity in the form of enforced standardization, homogeneity, and equality, based on the motivation of abstract and depersonalized national devotions and personal fear of government punishment. They insist on the appearance of “social justice” without any actual commitment to this end on the part of the citizenry. As a result, enforced equality gives rise to resentment and ill-will throughout the citizenry, turning commitments to goods that ought to be widely shared—health and education—into hot-button political issues.

In both spheres, health and education only “work” when those working in those areas are motivated most deeply by care for the people they serve—especially those who are less powerful, less mature, less accomplished than the professions that should rightly be considered “vocations,” not merely jobs. Both spheres require care for the whole person in all of their complete and individual integrity, not treatment of people as “parts” whom we serve mainly for the advancement of one’s own career or profit. In both spheres, increasingly, those who purportedly serve others—doctors and professors, who purportedly serve persons as patients and students—know little to nothing about either. They have become good workers on an assembly line, putting heads on pins, ignorant of the “product” they make—its history, its current state, its ultimate end.

Both spheres also require a concomitant shared commitment to commonweal on the part of those who benefit from the contributions of the professions. Doctors and teachers are not simply to be viewed as providing a service for pay, subject to the demands of “consumers.” Viewed through this market-based lens, the “buyers” make the demands on the providers. However, this understanding undermines the proper relationship between trustee and beneficiary—the doctor or teacher is actually in a relationship of responsible authority with the recipient, and ought rightly to make demands and even render judgments upon the one who is paying for the service. The trustee has a duty and a responsibility to enlarge the vision of the recipient—in matters of health (how certain behaviors might have led to a state of illness, in what ways the person ought to change their lives outside the doctor’s office), and formation (thus, a student should be challenged by the teacher not only to do well in the subject at hand, but to become a person of character in all spheres of life). Both the market and the State, however, increasingly regard the recipients simply as “consumers,” a view that is increasingly shared by every member and part of society.

Both practices are most appropriately animated by a more encompassing conception of human flourishing, which both integrally serve. Both are increasingly reduced to a utilitarian logic that internally destroys the integrity of each sphere, and, in that destruction, requires the increased intervention and control by the State.

For much of Western history, there was an understanding that there were two spheres of legitimate authority and competence—the Church and State, religious and civil. As part of the modern project, the Church was stripped of all claims to competence other than purely private belief. Arguably, one result of the increasing separation of the Church from these practices has been a bounty of benefits deriving from an increasingly scientistic and utilitarian pursuit of each, both premised on the human ability to master and control nature. These achievements are constantly celebrated as the rewards of the modern settlement (though the long-term benefits from this “mastery” seem tenuous to me).

But almost altogether unnoticed are the attendant costs of this transformation, costs that, ironically, make both health and education increasingly the province of the strong and wealthy. The appearance of crisis in each sphere at the same time is not coincidental—it is a consequence of a conscious set of decisions to banish motivations of Christian charity from almost every institution of human life. In their place, we have two deficient motivations and attendant practices—self-interest and depersonalized State-mandated social justice. It becomes clearer with every passing day that neither suffices, even as both grow stronger at the expense of the only motivation that might save us—the love of God to the point of contempt of self.

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37 Responses to Health, Education—and Welfare?

Oh, bravo, sir. You have clearly stated and delineated the logical and social support for an assertion I’ve been making nearly my entire adult life — that being how long I’ve been directly or indirectly affiliated with health care delivery (insurance and employee benefits) and public education (K-12 myself, three now-adult children the same).

For health care and education, the profit motive is inherently immoral.

It can be reiterated as you have above, with [b]ut almost altogether unnoticed are the attendant costs of this transformation, costs that, ironically, make both health and education increasingly the province of the strong and wealthy. Emphasis added by FE.

I’ve never been even a nominal Christian. I have my arguments, personal and historical, with your religious rhetoric. Given that and more, I stand ready to endorse fully your cause-and-effect assertion, the unintended or unexpected consequences of removing Church from the reins of State power being easy to see and the increasingly egregious damage to our social structures being the stark absence of a balancing force against the naked self-interest of the marketplace.

There is a way to correct that. The precedent is nearly as old as our republic. Elevate public health and public education to the same priority as national defense, make profit the subordinate of the effective delivery of both, and give cabinet-level agencies the responsibility and authority to keep it that way.

Oh, and those who expect it to be easy, take them behind the shed and give them the tongue-lashing lessons in reality they need.

I have long said that if liberals took seriously the principle of Separation of Church and State, as they pretend to do, they would never have allowed the State to intrude on the work of education, health care, and welfare – all enterprises of charity the impetus towards which comes from the Gospel of Jesus Christ.

But you are also right to remind us that neither are these endeavors fit for the world of commerce. They are the natural occupation of professionals, not businessmen. We forget that the word “profession”, like “vocation”, does not define someone who charges high fees for his personal services and by reason of greater wealth lives at a status higher than his fellow man. The doctor, the teacher, and, I might add, the lawyer, are all professionals because they have been called by God to serve others selflessly (their “vocation”) and answer that call as their “profession” of faith in Him. If they stand in the position of being given greater honor in their communities it should not be because of their greater wealth or material power, but, like the church pastor, because they have dedicated their lives to the service of others rather than themselves, and have taken time to acquire the knowledge and skills to do so fruitfully.

I add the lawyer to your list because, just as the pursuit of wealth has corrupted education and health care, making both unaffordable to the common man, so lawyers have been deflected from the calling to defend the accused, be peacemakers in their community, and labor for justice in the resolution of conflict, into becoming hired guns, doing the bidding of those already wealthy and powerful to direct and control the lives of others, both through commerce and through government.

However, aren’t both Left and Right motivated by the common fear that there will never be enough people who “care” to fulfill a modern society’s education and healthcare needs? Thus, to obtain sufficient levels of both, the Left seeks to compel through government action and the Right seeks to motivate through the opportunity to profit.

And isn’t it true that this common fear arose by the 1930s, if not by the late 1800s, when by all indications the country was far more religious — and uniformly Christian — than it is now?

I’m not saying that the author is not on to something, but how will more Christianity really resolve the fears of Left and Right when far more Christianity failed to resolve the issue of supply in a far more religious era?

This is excellent. Thank you, Prof. Deneen, for contributing to TAC. I hope to read a lot more of you in the future.

It is easy to be so fired up (read, distracted) by the bitter argumentation between the right and the left that the ends of education and health are not even considered. I had not considered the two issues in this light before.

Perhaps a question for a future article is whether our approach to health and education can be reformed from “self-interest and depersonalized State-mandated social justice” to one based at least on some concept of the common good. Sadly, in my view, our post-Christian nation doesn’t seem likely to recover Christian social teaching anytime soon. Is there a sustainable secular version of it that could be recovered?

“As a result, enforced equality gives rise to resentment and ill-will throughout the citizenry, turning commitments to goods that ought to be widely shared—health and education—into hot-button political issues.”

If this is even remotely true it is true only in our own benighted country. The state-managed health-care systems in virtually all other advanced countries in the world are widely valued and accepted, have better outcomes, and are cheaper than our own. Furthermore, our particular private health-care system has zero advocates anywhere else.

But I would argue even in this country your argument doesn’t hold much water. Social Security and Medicare hardly generate “resentment and ill will,” except perhaps among ideological conservatives. If Obamacare, originating from a conservative think tank, didn’t become the deliberate target of a vast right-wing propoganda machine, I doubt it would generate much resistance at all – probably even less so if “the state” had simply proposed Medicare for all.

Finally, I think even your fundamental premise is quite wrong. There has never been a time in history, even at the height of the church’s power and influence, when health and education were NOT seen as the province of the wealthy.

(1) Whether it would be ideal, in the best of all possible worlds, for education and healthcare to be handled entirely by churches; and

(2) Whether such a thing is even remotely feasible in the real world we live in.

No doubt there are many interesting arguments, pro and con, that can be made on the first issue. But I have little doubt that the answer to the second issue is “no,” which makes all argument on the first sort of moot.

…the work of education, health care, and welfare – all enterprises of charity the impetus towards which comes from the Gospel of Jesus Christ.

Not meaning to be argumentative (well, not right away), but may I respectfully prompt you to read up on the early history of public education in the United States, the Protestant hegemony that controlled it, and the Roman Catholic dispute with them that lead to the parochial school systems.

It would seem to me that if such a result can be caused by an argument over the text of a prayer to a common God, it is a serious rebuttal to any implication that when it comes to health care and education (at least), religion is the primary motivation for them; especially when the religion in question has such a long history of intolerance towards contradictions or challenges to its dogma and doctrine, especially towards their own siblings-in-faith.

I laud your sentiment, sir. I do not condone even subtle suggestions that the US is, shoule be or must be a Christian nation when my first thought is to look at the track records of Islamic nations. Some of them are pretty okay. Some are guilty of some egregious acts. I focus on Christians because they are my fellow citizens, but I must gently remind them that Christian nations past and present occupy both categories. And that is why we have the First Amendment, an original clause banning religious tests for holding government office, and a ubiquitously supported tax exemption for religions and their houses of worship.

Not that it matters because I think the pooch here was screwed long ago as to both our education and health-care systems and now can’t be unscrewed, but I for one believe that Deneen’s comments here are dangerously ahistorical in at least one important way, and thus potentially damaging.

I refer not to Mr. Deneen’s fine talk about the previous involvement of religions in the education and health-care fields, but the overall sense he imparts that the Right and the Left (or call it the free-marketers and the statists) have been equally right and wrong concerning same.

Or, to put it another way, the indications Mr. Deneen gives that the free market never really rendered a reasonably satisfactory situation for either.

I will leave it to others to address the education system, but once upon a time, say going back to the 1960’s, I think it can easily be said that the free market had given us exactly what free market economists say they do: Given us a very very high quality with the lowest possible prices. Either we had the best health care in the world or close to it, and people *routinely* went living without health insurance because health-care costs were entirely reasonable, increasing at just about the inflation rate that everything else did.

So no, Mr. Deneen, the free market system *did* as best a job as any system could do back then. And what screwed it up in my opinion at least was the failure of the statists to enact what the State should have done which was to just make sure that those falling through the cracks in that system were reasonably taken care of. Instead of doing so, via the insane structuring and expansion of those State benefits, was to utterly distort and destroy that free market that had worked so well. To the point where people could give away their millions in savings to their kids, or blow same in Las Vegas, and then walk into however long a stay as they lasted in a uber-expensive nursing home on the taxpayer’s dime from the word “go.”

No different than what the car market would look like today if those forty-some years ago you subsidized the hell out of a huge percentage of car buyers (in the health-care field, the old and the poor). I.e., the rate of car-price inflation sky-high and multiples of the general inflation rate, the huge percentage (if not all) of those cars being produced dripping with every gim-crack and lavishment imaginable, and people buying cars at a ridiculous rate.

Like I say, it’s way way too late to go back (which is why I for one am for a One-Payer plan), but let’s at least get our history right. Before, say, we grant the equivalence between the free market and statism that you are drawing and, say, decide why the hell not socialize, say, our agriculture industry. Whereupon in a mere couple of decades or so you won’t be able to find a loaf of bread costing less than the $350 a GP charges today just for you to walk into his or her office. (Nor indeed any loaf of bread not “necessarily” topped with every imaginable lavishment known to man, including probably flakes of gold.)

Deneen is a journalist who we should listen to given that he is one of the few conservatives who understands that the market is just as destructive as the state. So long as conservatives do not focus as much attention on criticizing the market as they do on criticizing the state, they will end up as the mouthpieces for big business instead of supporters of church, family, and tradition.

I might argue the Church and the State are but two different forms of the same bureaucratic monstosity in a lot of cases. Wouldn’t those that argue we shouldn’t take our direction from Washington DC say the same if the orders came from Rome?

An excellent article, as usual. One caveat on the use of the term “charity,” since it was something different that it is today. This was not, in the main, “individual” charity, but social charity. The work of the Church was supported by what we would call today “taxes.” The tax system of the time was based on fees on the land, not on incomes. Hence “fiefs” and the “feudal” system. The Church owned one-third of the land and kept the taxes for her own works. When the Church lost her lands, she lost the ability to perform these works. The seizure of the monasteries and guild lands, for example, nearly bankrupted Oxford and Cambridge, since they were largely supported by scholarships from monastic lands.

William, spot on, since the principle of the separation of Church and state was originally a medieval principle designed precisely to keep the prince out of the Church’s business. It functions today to keep the Church out of the Church’s business.

I find this article shallow and pedantic. How is the Church’s approach really any different than the capitalist approach? Both promise the actor a reward, albeit more more tangible than the other. Fiat money vs. fiat heaven.

If not for their expectation of a very real reward in the after life, who would still be out doing the profit’s(sic) work? No one.

Don’t kid yourselves into believing you’re all doing “charity” without an expectation of payment of one kind or another.

However, “the Church” (and that phrase has widely different meanings in the USA) cannot provide medicine today, even though the Church did provide health care in the middle ages. That’s because medicine today derives from applied science (biology, genetics, physics, chemistry.)

The Church is not making science. Scientists and medical schools are. Pharmaceutical and medical device industries are producing the drugs and equipment.

I don’t see the Church ever creating these kinds of innovations. So it’s not clear how the Christian churches are supposed to fill any analogous role in the modern age.

I have no problem with Catholics, Presbyterians, Lutherans, and all the other Christian denominations operating their own hospitals and schools (and legal clinics), even those which still bear their names but are otherwise now institutions answering to the state and their creditors. Their doctrinal differences, which led them to institute competing school systems (the Protestant schools becoming Secularist when Protestants forfeited their control of the states which operate them), does not extend to their charitable inclinations, which come from the same Spirit. Nor do a I have a problem with Jewish and Muslim schools and hospitals, demonstrating that the Spirit of Christ operates even among those who don’t recognize whose spirit is moving them.

The fact that God’s Spirit works through even competing charitable missions should allay Adam’s concern that a single Church bureaucracy might supplant the current State bureaucracy which governs all hospitals and all publicly funded schools.

Essayist-Lawyer,

The real world in which we live is not very different from the Soviet world which existed behind the Iron Curtain. When the curtain fell, as well as the state structure which supported it, it was the Church, as suppressed as it had been and as consigned to irrelevancy as the State had sought to confine it, which filled the sudden vacuum – at least so much of the vacuum as wasn’t filled by the robber barons worshiping in the Church of Mammon.

Phil,

It is obvious you don’t know much about Christianity. No one who knows and accepts Christ’s Gospel engages in charitable work in the hope of thereby earning entry into Heaven. They know their “tickets” were fully paid for by Christ on the Cross, and were given to them as God’s free gift.

I question your assumption that we are a Communist dictatorship (I’m pretty sure that a forum like this would not have been allowed in the Soviet Union), but we’ll let that go. If your point is that if our state collapsed, it would leave a huge power vacuum that something would have to fill, I would agree. Still, as you yourself acknowledge, it would be foolish to airbrush out the robber barons who filled a large portion of the vacuum when the state collapsed and pretend it was solely churches. I have every reason to believe that the robber barons would be the primary ones to fill the vacuum if our state collapsed as well. Come to think of it, I can’t think of a single example when a state collapsed that the resulting power vacuum was filled by anything other than robber barons of one type or another, although occasionally (Medieval Europe for instance), churches played at least some role. But I think you fool yourself if you think that role was primary, either in the Middle Ages or in post-Soviet Russia.

The main problem with this bootless nostalgia for the Good Old days is that it seriously misunderstands what the Church was back then. It was not an optional institution, and its charity was not voluntary or individual. Depending on the time and place the Church was either a quasi (and powerful) governmental institution in its own right, with the power to demand mandatory tithes and other levies, or else it was an arm of the government, His Majesty’s Bureau of Faith hand Charity, with its funding coming straight out of tax revenues. (In some parts of Europe remnants of the latter arrangement are still in place).
And of course today we have another problem which would preclude a return to the Church as welfare provider: we do not have a “The Church”, we have churches plural, a great multiplicity of sects, including non-Christian religions. Apart from barely tolerated Judaism, that was not the case for most of Christiandom’s history. There was only one Church in any given locale, Catholic or Orthodox, and later, maybe, Lutheran or Reformed or Anglican; other churches were not welcome, sometime suppressed at the stake, sometimes simply kept underground. How would we even begin to outsource health, education and welfare to “The Church”– which one would we pick and how would it be funded?
Finally, healthcare is not exactly in bad state. Not to denigrate centuries of monks and nuns doing what the could for the sick and dying, but is there one person here who can honestly say they would prefer healthcare c. 1300 to today’s?

@ William
I don’t think that answer allays my concern at all since all manner of mischief occurs within the framework of entities built by the frailty of man, including the Church as understood in it’s larger sense. One need not question the piety of individual providers of care to understand the largeness of any organization can lead to tyranny both big and small. In reading Angela’s Ashes my take away from some of the scenes involving Frank McCourt’s mother seeking aid was that there was not much difference whether it be from the parish or the government agency. Both treated her as a non-entity. Would you put as much faith in the Madrassas as the source of care and education in this country? Is it the source or the structure?

I neither said nor assumed that the United States is a Communist dictatorship. But it is imperial power whose overseas possessions will no longer sustain the cost of maintaining them. Neither do we have a flow of income from abroad to support a standard of living unsurpassed in the world and, in particular, a generous social safety net, the demands upon which are being compounded in the attempt to satiate our increasingly impoverished (spiritually and materially) masses.

It is true, when the Soviet Union collapsed, the Church had been so eviscerated that it was not able to fill the vacuum of what had been state services. Robber barons did, robbed much of the public fisc, and Russia suffered a breakdown of social services and a growing mortality rate unknown outside the Third World. The Putin regime has put an end to much of this corruption (excepting its own), and the influence of the Church has not been greater since the October Revolution.

Other states, such as Poland, which already had a strong Church when the Wall came down, has not suffered so, as both the institutions of civil welfare and the mindset of Christian charity to support them were there. Unlike Poland or Russia, America does not have a tradition of a State Church to which to return when our imperial edifice folds, but if that collapse takes the national government with it, the Church and the faith in God which still adheres to the American soul will be equipped to step in and restore such social services as health care and education, if not at current levels, yet with less expense than burdens us currently.

Where did you get the idea that it was “The Left” that favored “state-mandated expectations and standards?” Standardization, state mandates and high-stakes testing to enforce these have been largely the product of the combination of the Corporate Class, Democratic Centrists and the Republican Right.

“The Left—while seemingly friends of charity and “social justice”—are deeply suspicious of motivations based on personal choice and religious belief.”

First, the Left is not particularly inclined towards charity since we find it less efficient and less effective than good public health, education and welfare programs, as bourne out by decades of state rankings in those categories. Also, while the Marxist Left may not be fans of religious belief, the broad Left includes many people with religious and spiritual beliefs. Not to mention that you are far more likely to find supporters of “personal choice” when it comes to human reproduction, sexuality and recreational drugs on the Left than you are on the Right.

“They [the Left] desire rather the simulacrum of charity in the form of enforced standardization, homogeneity, and equality, based on the motivation of abstract and depersonalized national devotions and personal fear of government punishment.”

I may loathe the corporate version of “diversity” and denounce “multiculturalists” who cast a rosy sheen on footbinding and African Kings, but its not the Left that is demanding English-only, assimilation, the end of “hyphenated” Americans and restricting immigration to the countries and continents that “share a heritage” with (white) Americans. And for all of the stupid speech codes on college campuses, and the supposedly heavy hand of governmental regulation (“Damn those consumer and workplace safety laws!”), the Drug War has been driven mainly from the Right and the most egregious assaults on civil liberties have come from Republican and Centrist Democratic Presidents over the opposition of much of the organized, if broadly defined, Left.

“They [the Left] insist on the appearance of ‘social justice’ without any actual commitment to this end on the part of the citizenry. As a result, enforced equality gives rise to resentment and ill-will throughout the citizenry, turning commitments to goods that ought to be widely shared—health and education—into hot-button political issues.”

I may get in trouble for saying this, but Same-Sex Marriage, the Boy Scouts, Title IX and the Confederate flag are secondary issues compared to health, education, voting rights and the ability to exercise one’s constitutional rights. I may be able to wait for a sufficient number of the public to change their minds about SSM, but to hell with public opinion when it comes to grossly unequal access to education, health care, housing, the voting booth and fundamental civil liberties. And let’s also take a reality check here. Equality in education or health care wouldn’t be such an issue if the middle class and working class whites still had fully-funded schools, good health insurance, decent pensions and secure, well-paid jobs. In other words, it’s still the Ruling Class’ fault, because it has spent the last 30+ years engourging itself at the expense of first, working class people of color, then working class whites and middle class people of color, then middle class whites, and now finally, even some segments of the formerly very comfortable upper middle class.

TomB says: “…going back to the 1960′s, I think it can easily be said that the free market had given us exactly what free market economists say they do: Given us a very very high quality with the lowest possible prices. Either we had the best health care in the world or close to it, and people *routinely* went living without health insurance because health-care costs were entirely reasonable, increasing at just about the inflation rate that everything else did.”

No, incorrect. Medicare and Medicaid, even more than Social Security, pulled or kept millions of senior citizens out of poverty. Prior to those two programs, seniors were the age cohort that suffered the highest rate of poverty. Now, they suffer from the lowest rate of poverty of any age cohort. Not to say that the present system doesn’t include perverse incentives such as stripping sway all of your assets in order to qualify for government assistance, but free market health care was no panacea back in the 60’s.

I question the characterization of the Right that describes the motivation of charity as deeply suspect by them. I include libertarianism on the right end of the spectrum as heirs of the liberal tradition. I have read much of Rothbardian libertarianism and Rothbard is careful to describe libertarianism as a political philosophy, not a moral philosophy for guidance on moral or religious matters. It seems to me that you can be on the “Right” and still hold to the necessity of charity for social well-being. Those on the Right would probably hold that adherence to “free market” principles has brought a great prosperity, but cannot be counted on as the sole “glue” holding society together. This article strikes me as offering too great a reductionistic view of free-market capitalistic thought.

But that’s a straw man, cka: I never said it was a panacea, just that it provided about the best (in quality and in low prices) that any system could. (After all we live in a world of limited alternatives.)

And I did note the necessity of gov’t providing a health-care safety net for those who “fell through the cracks.”

Now of course that we haven’t totally destroyed that free-market situation and are still enjoying its benefits it’s easy to forget them and claim that the far more socialized alternative we are instituting will be far superior.

But of course that’s *always* what socializers say at first about whatever they are taking over, and here especially it’s far too soon to go criticizing that which we once mostly had. While there’s been plenty of corrupting of that old free-market health-care system (in my opinion largely causing the plenitude of the problems we have with it in the present), we are now just *starting* to institute in a big way the alternative that we are told will be so superior.

So as Marx once said (Groucho that is, to Margaret DuMond in response to her saying she’d never been so insulted in her whole life by a comment that Groucho had just previously made to her): “Well, it’s early yet.”

And couldn’t teachers and healthcare providers easily be motivated not by an abstract concern for the People nor by market motives but by a genuine concern for their craft and for the real people they locally serve? I’d describe many of the teachers and doctors I know in that way, secular and otherwise. I don’t think dedication to craft and community is lacking in the secular world, although outlets for its expression certainly are.

Above all, we need a re-dedication to craft and community for its own sake, not a reversion to governance by an ecclesiastic system of dubious metaphysics and authority.

The main reason that health care and education were relegated to “charity” is that, prior to government subsidies or loan programs, they both require incurring huge sunk costs before a dime of revenue is made. And when that revenue is made, it was slow, leaving creditors with low returns on investment.

In both instances, something had to be done to defray the dual problem of high sunk costs and a low rate of return on investment. In such instances, it’s generally more efficient to address the sunk costs problem over the revenue problem (as fewer market distortions ensue). But that’s not what happened. Rather, the government provided consumers with greater money to spend on health care and education, which supported the charging of higher prices which, in turn, increased revenue.

I don’t buy the train. It may start at the right station, but somewhere along the trip it get derailed.

The advance that education could be more effective if it was run via some free market model is relatively new. Our educational systems while they were begun by religious and private organizations have been under the domain of local and state governments.

As one would expect MA was one of the earliest models for taxing to fund schools and it it became official in 1818. And along the way prior and afterwards public education was born as a government cause.

The attempt to make the leap from religion to private just does not work. given the history of the US educational system.

It has only been in the last quarter century that the private sector has been considered to make educational bureaucracy more efficient and educators more accountable.

But by and large I have I just don’t the advance here. The push to remove kids from the public educational system has been in direct response to an increased number of failing institutions – not a bid to make profits. The ever growing liberalization of teaching has also been to cause.

Let’s face it, if you r son comes home and tells you that in sex education classes of human biology – the instructor covered self gratification, premarital relations, and same sex behavior as just fine and healthy as long as it is safe —-

Your likely to pitch a coniption and remove your son, ASAP, like minded parents are also going to receive redress. Since the advance of more modern techniques of teaching the graduation rate drops as the crime rate goes up in any school, parents are going to look for better places to educate.

Upon taking the issue with local school board and are confronted with the teachers’ union which in essence tells parents to shut-up, because they don’t know what you are talking — and I am being extreme as to language, but not to effect.

Well, you are headed elsewhere . . .

But bleeding out the school choice issue which still utilizes taxes while providing more parental voice of their child’s education — by calling it a free market cabal — is misleading.

Stef, your comment, “The Church is not making science. Scientists and medical schools are. Pharmaceutical and medical device industries are producing the drugs and equipment.

I don’t see the Church ever creating these kinds of innovations. So it’s not clear how the Christian churches are supposed to fill any analogous role in the modern age.” seems to disregard the many excellent Catholic, Protestant, Jewish and other universities and hospitals in our nation. Additionally, science and religion are inextricably linked to one another rather than mutually exclusive. In fact, many of the world’s greatest scientists were devout and motivated by religion.

While the finer points of Mr. Deneen’s piece are debatable I think the general premise that both state control or an unfettered free market are problematic is spot on.

Charity in the US has done nothing but decline since the New Deal in the 30’s and social security. The government has taken upon itself the responsibility we have to our neighbor. Recall Scrooge’s response to the orphanage leader’s supplication, “do you not receive funds from the government? I pay my taxes and have done my part.” (sic.)

I am of the opinion that it is time to return power to the people – turn education, welfare, and medical care over to the non-profit sector. This has the potential to infuse these systems with an energized and involved local volunteer base willing to donate to and inspect those same systems. As for the governments ability to do the same – I think the evidence is overwhelming that the government s failing miserably.